Sample Record for 2025-12-23-12
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000731 DEA: 042Q4404 EFIS: 0419000013
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-121-6.5,8.4
Work Description: REMOVE BR AND AC SURF, CONSTRUCT BR DECK, RAILING AND POLYESTER CONC.
Location Description: SONOMA COUNTY NEAR SONOMA AT YELLOW CREEK BRIDGE AND AT ARROYO SECO BRIDGE
Contractor Name: GORDON N. BALL, INC.
Contractor Address: Unknown
Resident Engineer: Fabio La Serna Structure Rep.: Jeremy Light
Sample Information
DIME Sample ID: 2025-12-23-12
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Petaluma Field Laboratory
Sample Organization Contact: (510) 385-6841
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 12/23/2025
Date that the sample was received by the laboratory/organization performing the testing: 12/23/2025
The quantity of what the sample constitutes: +75cy
A brief description of the sample: 1x 4 Pcc Aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Shamrock
Material Information
Source Identification (SMARA, name of Pit or Job Site): Orca
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Stockpile @ Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
Tests Assigned to this Sample
| DIME Test ID | Test Method | Assigned Date | Test Date | Assigned By | Assigned Lab | Test Comments | Assigned To |
| 2025-12-23-12-1 | CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse Aggregates | 01/05/2026 | Not scheduled | Anthony Valdez | CT D04 - Petaluma Field Laboratory | | |
153212
